| NPI | 1164449674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 10657) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO R5J60) |
| 207L00000X Anesthesiology (Licence: WI 50121-20) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-09-20 |